Provider Demographics
NPI:1346346558
Name:DEGUZMAN, ALICIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:
Last Name:DEGUZMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 E 40TH ST
Mailing Address - Street 2:SUITE 501
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-1201
Mailing Address - Country:US
Mailing Address - Phone:212-686-0888
Mailing Address - Fax:
Practice Address - Street 1:30 E 40TH ST
Practice Address - Street 2:SUITE 501
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1201
Practice Address - Country:US
Practice Address - Phone:212-686-0888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043266122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist